CGRP Antagonists: How Acute and Preventive Options Differ
Gepants, monoclonals, acute, preventive — the same target, four different jobs. A map of the class.
One target, several jobs
Every drug in this class interferes with calcitonin gene-related peptide, a neuropeptide central to migraine pain. What separates them is not the target but what they are for and how long they act.
Small molecules — the gepants
Oral, short-acting, taken by the patient. Some are licensed acutely, some preventively, and at least one is licensed for both — which is why "is it a gepant?" does not tell you how it is used.
Monoclonal antibodies
Injected, long-acting, given monthly or quarterly. Preventive only. Some bind the CGRP ligand, one binds the receptor; in practice the distinction matters less than the dosing interval and how someone feels about injections.
Choosing between them
Frequency of attacks, whether prevention is already needed, tolerance of oral versus injectable, cardiovascular history, and — realistically — what is reimbursed. There is no ranking that holds across patients, and a comparison that produces one is describing a trial population rather than a person.
What the class does not do
None of these are analgesics, and none work by constricting blood vessels the way triptans do. That is why they remain an option for people with cardiovascular contraindications to triptans — the most clinically useful thing about the class.